An investigation to determine the nutritional adequacy and individuals experience of a very low fat diet used to treat type V hypertriglyceridaemia

Background: The management of Type V hypertriglyceridaemia at some centres involves the use of a very low fat diet (15% energy as fat). There is no published research examining compliance with, or nutritional adequacy, of this treatment. This study assesses the nutritional adequacy of the diet and examines barriers and enablers to adherence. Methods: Fifty‐four eligible patients were invited to take part. Eight males and one female agreed to participate. One male later withdrew. The mean age of participants was 49.4 years (SD 12.9 years), their mean BMI was 30.4 kg m^?2 (SD 3.4 kg m^?2) and their mean triglyceride level was 8.5 mmol L^?1 (SD 5.6 mmol L^?1). To assess nutritional adequacy and compliance, 3‐day dietary records and telephone based diet histories were used and analysed using CompEat. Patients’ experience was investigated using semi‐structured telephone based qualitative interviews. Qualitative data was recorded, transcribed and analysed using thematic analysis to allow elucidation of emerging themes. Results: Fat accounted for 22.5% of dietary energy and compliance was considered difficult. Barriers included lack of accessible nutritional information, increased patient burden defined as inconvenience and the persistent awareness of potential or actual ill health, lack of appropriate food choices, other peoples’ ignorance, lack of flavour and variety, a desire to broaden the palate, cost, social pressure and prior negative experiences with dietitians. Enablers to compliance included nutritional awareness, desire to maintain good health, building on their nutritional knowledge base, behaviour and lifestyle modification, developing a routine, the support of family and friends and supportive eating environments. Conclusion: Compliance could be improved through extensive education on labelling, eating during special occasions such as Christmas, birthdays and eating out.     

Spatial dynamics and epidemiology for AIDS in remote areas in French Guiana

Although AIDS care is generally improving in French Guiana, disparities among regions and certain key populations remain significant. The purpose of this study was to describe the spatial and clinical characteristics of people living with HIV (PLHIV) in remote areas in comparison to those followed in hospitals on the urban coast of French Guiana. The data presented were obtained from outpatient on primary care centers located in rural regions away from the urban coast. Data were compared with that from medical records of PLHIV treated in French Guiana's urban care. The evolution of the annual rate of discovery of HIV seropositivity indicates a lag in remote areas as compared to urban and coastal areas. In recent years, the epidemic appeared as particularly active in rural areas among Brazilian patients. The median age of PLHIV in remote areas was 43.8 years, the sex ratio (M/F) was 0.93. Nearly 37% of PLHIV were discovered with advanced disease (<200 CD4/mm3). The percentage of virological success after six months of HAART was 80% and 88% in remote areas and urban area, respectively. Efforts must be made to control and halt the spread of the HIV epidemic, as these remote sites represent strategic points.     

Malignant Deciduoid Mesothelioma: case presentation of an exceptional variant and review of the literature

Background

Malignant Deciduoid Mesothelioma (MDM) is an extremely rare variant of epithelioid mesothelioma. It was first described in young females, in the peritoneum, and its relation with asbestos was not well defined.Later reports, have shown that this variant may also occur in the pleura, the pericardium and the tunica vaginalis of elderly people, who had been exposed to asbestos.

Case presentation

We report a case of malignant deciduoid mesothelioma that occurred in the peritoneal cavity, and the omentum of a 35-year-old woman. The patient had never been exposed to asbestos.

Conclusions

Through this observation, we describe clinical, histopathological, and immunohistochemical findings of deciduoid mesothelioma, and review the literature reports.

     

Vitamin D deficiency in Egyptian and Yemeni primary knee osteoarthritis patients: Relation to physical function and radiographic severity

Aim of the workTo investigate the relationship between serum 25(OH)D (25-hydroxyvitamin D) level and primary knee osteoarthritis (KOA) in Egyptian and Yemeni patients, and to demonstrate its impact on physical function and radiographic severity.Patients and methodsThis study included 82 KOA patients; (41 Egyptian, 41 Yemeni), together with 80 controls; (40 Egyptian, 40 Yemeni). Serum 25(OH)D level was measured using enzyme-linked immunosorbent assay. Physical function was evaluated using 6-minute walk test (6MWT), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score and chair stand test (CST). Knee radiographic grading was based on Kellgren-Lawrence (KL) scale.ResultsThe mean age of Egyptian and Yemeni patients was 53.4 ± 7.1 and 56.2 ± 7.5 years respectively. Serum 25(OH)D level was significantly decreased in Egyptian (13.3 ng/ml;5.3–39.6) and Yemeni (9.5 ng/ml; 3.8–49) KOA patients compared to their corresponding controls (27.7 ng/ml; 12.8–51.4 and 20.9 ng/ml; 8–45.5; p < 0.001 each) and was the only significant predictor of KOA in Egyptian (p < 0.0001) and Yemeni (p = 0.001) patients. Yemeni patients exhibited significantly lower 25(OH)D compared to Egyptian patients (p = 0.008) with a significant increase in smoking (p = 0.002) and niqab wearing (p < 0.001). Serum 25(OH)D level significantly negatively correlated with radiographic grading in Egyptian (p = 0.03) and Yemeni (p = 0.02) patients. Regression analysis showed no relationship between 25(OH)D levels with WOMAC, 6MWT or CST; the relation was significant with KL grading in Egyptian (p = 0.01) and Yemeni (p = 0.005) patients.ConclusionThere is an association between vitamin D deficiency and primary KOA especially to the radiographic severity but not to physical function in Egyptian or Yemeni primary KOA patients.     

The same genetic defect in three Tunisian families with Bernard Soulier syndrome: a probable founder Stop mutation in GPIbbeta

GPIbα, GPIbβ, and GPIX are three candidate genes for a rare genetic bleeding disorder named Bernard Soulier syndrome (BSS). These genes are unique in the genome and encode for glycoprotein subunits of the GPIb-IX complex. Quantitative or qualitative deficiency in this complex is often associated with BSS. Here, we report the novel variant of BSS in which Ser23 of GPIbβ is substituted by a Stop codon causing a premature termination of translation, recently described in one family. This genetic defect is revealed in three unrelated BSS patients. The pedigree was determined for two families (F1 and F2) and revealed the homozygosity of the mutation in the two patients and its heterozygosity in parents. In the third family, the patient DNA was heterozygote with the same Ser23 Stop mutation in addition to two missense heterozygote mutations (Asp 51 Gly) and (Ala 55 to Pro). We studied the effect of the Ser23 Stop mutation on the expression of the complex. Our findings confirm that the identified GPIbβ mutation is responsible for the BSS phenotype and hampers the GPIb-IX complex to form on the platelets’ surface. Regarding the scarcity of the BSS syndrome, the occurrence of the same mutation in three unrelated families would suggest a BSS founder mutation in Tunisia.